Information Collection

Section 2719A - Patient Protections

IC 193322 under ICR 201307-0938-014 · OMB 0938-1094.

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Information Collection (IC) Details

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IC Title:	Section 2719A - Patient Protections	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 45 CFR 147.138

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 8,382	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 38 %

	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	1,575,816	1,575,816
Annual IC Time Burden (Hours)	1,576	1,576
Annual IC Cost Burden (Dollars)	39,395	39,395

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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.